Know Your Number !!

Recent reports show one in five Americans do not know their blood pressure number.  High blood pressure (hypertension) is a major modifiable risk factor to reduce the risk of stroke , heart attack , kidney disease and heart failure  ( and death).

Quick Stats:

High blood pressure, or hypertension, in the United States has increased from approximately 50 million from 1988 through 1994 to 65 million in the period from 1999 to 2004. In 2005, an estimated 33.6% of the population, more than 73 million Americans, had hypertension. From 1995 to 2005, the death rate from high blood pressure increased 25% and the actual number of deaths increased 56%. In 2005, high blood pressure killed approximately 58,000 people.

Why you should know your number:

Hypertension is a major risk factor for cardiovascular disease and renal disease, and early data indicates that untreated high blood pressure shortens life expectancy by approximately five years. The higher the blood pressure, the greater the risk of MI, heart failure, stroke and kidney disease.

The risk of cardiovascular disease beginning at a BP of 115/75 mmHg doubles with each 20 mmHg incremental increase in systolic BP or 10 mmHg incremental increase in diastolic BP. In younger people, elevated diastolic BP is associated with more cardiovascular disease risk than increased systolic BP.  (Be sure you didn’t miss my post earlier this week about the alarming data recently reported from a Canadian Study on childhood obesity and the measured changes in aortic stiffness- basically young overweight children showing early signs of heart disease, as early as at 13!) However, starting at age 50, systolic BP becomes the more important risk factor.

Hypertension Classification

Blood pressure classification is based on the average of two or more properly measured, seated BP measurements made on each of two or more office visits.

Blood Pressure Classification in Adults1
BP Classification Systolic Blood Pressure Diastolic Blood Pressure
Normal < 120 < 80
Prehypertension** 120 to 139 80 to 89
Stage 1 hypertension 140 to 159 90 to 99
Stage 2 hypertension = 160 = 100
** “prehypertension” -These patients are at increased risk for clinical hypertension. Although they don’t require drug therapy, they should practice lifestyle modification. Lifestyle changes can potentially lower BP and reduce the risk of progression to hypertension.

Know Your Number !

Post by David Dansereau for

David Dansereau
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1. American Heart Association. High blood pressure statistics. American Heart Association Web site. Accessed on May 23, 2010.


Obese Kids at Increased Heart and Stroke Risk ?


Passing Along: Just posted on

Childhood-Obesity Study: Young Obese Kids Have Old Hearts

In this study that looked at childhood-obesity and the changes in the heart, it was the aorta specifically that showed early changes, consistent with the hearts of much older adults.

Permalink — click for full blog post “Childhood-Obesity Study: Young Obese Kids Have Old Hearts”

Are “heavy” kids at early risk of cardiovascular disease and stroke ?


Childhood-Obesity Study Says: “YES” !!


Post by David Dansereau


Do Politicians in Cumberland RI Know Stroke Warning Signs?

Do Politicians in Cumberland RI Know Stroke?
Do Politicians in Cumberland RI Know Stroke?

I certainly hope so and perhaps they will include the stroke warning signs in their political profiling and typical canned candidate sound bites * in the Valley Breeze because the importance of knowing the stroke warning signs have apparently taken a back seat to politics, at least for “one more week”.

Here’s what Tom Ward, publisher of the Valley Breeze had to say in response to my request to print a PSA (public service announcement)  in our local paper about knowing the  stroke warning signs.

Show quoted text - 

“It will not be printed next week. We are hip deep in political stuff for one more week.  After  that will be fine.”

Thank you.

Thomas V. Ward, publisher
The Valley Breeze

Show quoted text - 

Valley Breeze;
“I was disappointed to learn that my reply to the recent editorial by Sharon Coyle which appeared in the Breeze on pediatric stroke was not included in your publication this week.  I hope that next week you might consider publishing this in the Valley Breeze to help educate readers (especially in Cumberland) about knowing the stroke warning signs.  Thank you for considering this request”.
David Dansereau

Cumberland RI

Know the Stroke Warning Signs. Act in time.  Call 911

When it is more convenient, or a light coverage week, perhaps I’ll have better luck with the local media.  In the meantime, I’ll keep at it*, but you don’t have to wait a week or more for a review because here’s what you should know now:

Learn the FAST test to help identify stroke warning signs .

FAST stands for: 

Face: Ask the person to smile. Do both sides of the mouth elevate equally?

Arms: Ask the person to raise both arms. Do both arms lift equally?

Speech: Ask the person to repeat a sentence. Can they repeat? Are the words slurred?

Time: If the person shows any of these symptoms, call 911 or get to the hospital FAST.

It should be pointed out that there’s some controversy about the FAST test. The FAST test is great because it is simple but it leaves out a few more subtle but important signs a stroke or TIA (transient ischemic attack) or “mini” stroke may have taken place.  Here’s a link to a previous post about this controversy if you want to know more…

Bottom line:

Know as many signs and symptoms of stroke as possible.  Initiating treatment FAST is vital because time saved is neurons saved. Every minute during a stroke an estimated 2 million neurons and 14 billion synapses die.  Delays in treatment lead to brain loss  which make the road back to recovery more difficult if time is wasted.  Never assume the victim is “too young” to possibly be having a stroke.  The Coyle’s story from Cumberland as well as the unusually high incidence of stroke in town is proof there are young faces of stroke and regardless of the age, you must LEARN FAST to be able to act FAST to save a life.

*Did you know??

According to the RI State Plan for Heart Disease and Stroke Prevention (p.25), the goal set by the state  is – “By 2012, 18% of Rhode island adults aged 18 and older will know the four warning signs of stroke as described in the FAST campaign, including the importance of calling 9-1-1.” That’s right, 18%! So, if the goal is to get to 18%, I have to ask, where are we now??  Clearly, we are not getting this message and the media is certainly not acting FAST!

Perhaps one of our politicians up for election can start their next sound bite  by saying something like ,

”If (re)elected I’ll lower property taxes, fight to reduce state spending, protect social security, and fight for all Rhode Islanders to know the stroke warning signs and act in time to save a life”.

Article by David Dansereau

To read Shorn Coyle’s original letter published in the Valley Breeze  go here

New AHA/ASA Recurrent Stroke Prevention Guidelines Released

The American Heart Association and American Stroke Association published updated guidelines for recurrent stroke prevention online Oct. 21,2010 in the journal Stroke.  The last update to the AHA/ASA was in 2006, but results from several studies testing different interventions contributed to the need for the new report.  “We need to reevaluate the science every few years to optimize prevention,” stated Dr. Karen L. Furie, chair of the 18-member writing committee and director of the stroke service at Massachusetts General Hospital, Boston, MA in a statement accompanying the updated guidelines.

New recommendations in the guidelines cover control of risk factors, interventions for atherosclerotic disease, antithrombotic therapies for cardioembolism, and use of antiplatelet drugs for noncardioembolic stroke.

What did the new guidelines have to say about patent foramen ovale (PFO)?

According to the report, “evidence is also insufficient to establish whether anticoagulation therapy is better than aspirin therapy for secondary stroke prevention in patients who have a patent foramen ovale.”

The full report can be accessed at the American Heart Association and American Stroke Association website.

 update by David Dansereau for
New AHA/ASA Recurrent Stroke Prevention Guidelines Released

Will VH1 show Bret Michaels’ PFO Closure?

According to’s surgery blog Bret Michael’s is scheduled to undergo PFO closure in January.  In this quick poll, I’d like to know how you think VH1 and Bret Michael’s new show Life As I Know It will address the controversial medical topic of PFO closure.

Should VH1 show Bret’s PFO surgery and discuss the controversy?


According to VH1 Life as I Know It premires Monday October 18th

View trailers from  VH1’s  Life as I Know It

To learn more about PFO visit PFO Research


posted by David Dansereau for

Perhaps PFO needs to be better recognized as a “Syndrome” to get equal treatment

After all, accurate diagnosis and treatment of plica in the knee, or “plica syndrome”, has an accepted surgical option after conservative treatment and medical management has failed.

DP Dansereau, MS,PT for

First, here’s some quick background:

Plica syndrome, while being quite well known to physical therapists and physicians specializing in physical medicine and orthopedics, is not a common term people are aware of, unless perhaps they’ve been diagnosed as it being the possible source of their knee pain.  Plica-syndrome, often characterized by anterior knee pain, is most commonly found along the superomedial aspect of the knee.

The “plica” is due to remnant embryological tissue that compartmentalizes the knee during fetal development. The plica is sometimes considered  a “vestigial” structure, which means that it has lost its ability to function over time and does not functionally affect an individual whether it is present or absent.  It has been likened to the appendix, which can be a source of pain but lacks significant important function.

I’ll make a case here for quick comparison that a similar flap, or cardiac remnant in the atrial septum of the heart from fetal development exists.  In the case of this heart anomaly, this “vestigial” structure is often referred to as a patent foramen ovale or PFO.  This left-over fetal tissue  sometimes takes the shape of a flap in some hearts.  Some PFOs have been  described as “tunnel-like” in appearance under autopsy.

Patent foramen ovale has often been depicted as a defect or an incomplete closure in the walls of the chambers of the heart.  A patent foramen ovale can vary in size but the location is usually the same. As described in the literature, the flap like opening or hole is in the dividing wall (septum) between the upper two chambers of the heart – the left atrium and the right atrium.

Identifying a PFO is important because a PFO is a potential pathway for a blood clot to escape from the heart and travel to the brain, causing a stroke.   Similarly, the plica in the knee can get trapped and irritated to a point where it impairs normal joint ROM (range of motion) and can cause often less debilitating but still serious limitation to ADL’s (activities of daily living) when compared to the devastating effects of stroke.

How does this heart defect occur?

In the womb, all babies have a PFO. This is because a baby does not use its own lungs to filter and oxygenate its blood. Instead, it receives oxygen-rich blood from its mother via the umbilical cord. This blood has been filtered and oxygenated by the mother’s lungs. The PFO allows this blood to be sent directly to the brain, which has a high requirement for oxygen-rich blood during fetal development.

How common are PFO’s?

In most people, the two flap-like sections of septum which form the foramen ovale (or hole) fuse together after birth to form a solid dividing wall between the right and left atria. However, in an estimated 15-30% of the population, this area of the heart doesn’t fuse together and remains open or “patent”. This opening makes it possible for blood to cross from the right atrium to the left atrium—this is called a right-to-left shunt. The danger of blood shunting in this manner is that if it contains small debris or a clot it has bypassed the body’s natural filter (the lungs) and can pass directly up to the brain and cause a stroke.  Worldwide, it is estimated that approximately 500,000 people may suffer this type of stroke each year.

My Conclusion and the current Medical Paradox


When symptoms arise this is  where my comparison between PFO and Plica go down separate paths.   Here’s how current treatment differs:

Accurate diagnosis of both symptomatic plica and “symptomatic” PFO remains the predominant challenge.  The main difference is currently only with one syndrome the option of surgical treatment is widely accepted.   Why is symptomatic PFO not being fairly treated as a true medical syndrome?

I’d love for you to comment below.

DP Dansereau, MS,PT for

More Information / References:


PFO Research Foundation

Plica Syndrome

Many Stroke Patients Discontinue Meds After 3 Months

These stroke meds are critical for many survivors to help prevent secondary stroke.  What’s going on here with almost a 25% non compliance rate?

– DP Dansereau, MS,PT  for

According to a new study by researchers at Wake Forest University Baptist Medical Center  at least a quarter of patients who have suffered a stroke stop taking one or more of their prescribed stroke prevention medications within the first three months after being hospitalized.   The study identified several modifiable factors that are associated with stroke survivors’ compliance in taking medication that can help prevent recurrent stroke. The paper appears online in the Archives of Neurology.

Researchers at Wake Forest Baptist and Duke Clinical Research Institute looked at compliance issues, as well as system and provider issues, such as what type of physician the patients saw, what kind of follow-up care they had and the patients’ understanding of their medications.

The researchers studied 2,598 patients from the Adherence Evaluation after Ischemic Stroke-Longitudinal Registry to evaluate how many stroke patients continued taking their prescribed medications to prevent a second stroke three months after their discharge from the hospital. They found about 75% of those studied had continued with their full regimen of medications three months after discharge, while almost 20% of patients had stopped taking one or more of their prescribed medications and 3.5% of patients weren’t taking any of their medications at three months.

Researchers learned from the study that multiple factors were associated with persistence in continuing secondary medication regimens, including, among other things, the presence of cardiovascular disease and risk factors prior to stroke, having insurance, having a better quality of life, and having an understanding of these medications and how to refill them.


post by David Dansereau,MS PT for